Alternatives to conventional chest compression

Alternative techniques to precordial compression are sought to improve the return of spontaneous circulation after cardiopulmonary arrest. The pathophysiology of cardiac arrest and the methods to determine the efficacy of a new technique need critical re-examination. Vest cardiopulmonary resuscitation (CPR), active compression/decompression with abdominal counterpulsation (LifeStick [Datascope, Fairfield, NJ]) CPR, and ascending aortic balloon inflation with saline infusion are promising methods that have been shown to augment coronary perfusion pressure and improve the return of spontaneous circulation in animals. Preliminary studies in human cardiopulmonary arrest have been performed with vest CPR and ascending aortic balloon inflation with saline infusion, with favorable hemodynamic results. In parallel with the development of new methods, the availability and adequacy of bystander CPR should be re-emphasized.